Medicare Part D formulary

Changes to the formulary

Our Pharmacy and Therapeutics Committee thoroughly reviews medical literature and selects drugs for our formulary based on how safe and effective they are, among other factors. The committee meets quarterly to consider changes to the formulary based on new information or new drugs that become available.

Note: The presence of a drug on our drug formulary does not necessarily mean that your plan physician will prescribe it for a particular medical condition.

If there are any changes to the drug formulary or restrictions are added to a drug, and you are taking the drug affected by the change, you will be permitted to continue receiving that drug according to your drug benefit.

Getting an exception to the formulary

Drugs not listed on the formulary are called non-formulary drugs. When a Kaiser Permanente physician determines that a non-formulary drug is medically appropriate and necessary, that drug will be covered under the terms of your benefits (if you have a prescription drug benefit). If you do not have a prescription drug benefit, you will be charged the full retail price for the drug.

The most effective way to get an exception to the formulary is to send a secure email to your doctor. You and your doctor are best able to determine your medication needs.

You may also contact Member Services by submitting an online form. Or call Member Services, 24 hours a day, 7 days a week at:

English: 1-800-464-4000

Spanish: 1-800-788-0616

Chinese dialects: 1-800-757-7585

TTY for the hearing and speech impaired: 1-800-777-1370

If you wish to have a non-formulary drug that our physician does not determine to be medically necessary, you may file a grievance (or for Senior Advantage and Medicare Cost members, file an appeal) with Member Services.

Have questions?

For more information about how our drug formulary works (e.g., drug restrictions or plan limitations), please contact our Member Service Contact Center Monday through Friday from 7 a.m. to 7 p.m., or Saturday and Sunday from 7 a.m. to 3 p.m. (except holidays).